Alcohol Awareness Fraser Hoggan, Stephen Hounsom & Neil Strachan May 2007

1. Alcohol Awareness Fraser Hoggan, Stephen Hounsom & Neil StrachanMay 2007

2. Aim of Session To raise awareness of the Health & Social Implications of alcohol use and types of harm associated with alcohol

3. Objectives • Discuss cultural relationship with alcohol • Explore the effects of alcohol • Explore the harms caused by varying nature of alcohol use • Identify harmful drinking patterns • Increase awareness of sensible drinking messages

4. Accepted part of our culture? • We’ve been brewing alcohol since before the Romans arrived • Alcohol is deeply rooted in our culture and national identity • Used to celebrate, commiserate .... • Most people who drink alcohol do so without experiencing serious problems • Binge drinking and drunkenness have become much more common over the last decade – particularly among young people

5. Accepted part of our culture? • In 2006, Scottish Exec research showed that: • 1 in 5 Scots lie to avoid drinking • 1 in 3 Scots drinking more than they want • 1 in 2 young Scots have no idea how much they drink • Evidence would suggest that Scots are more concerned about how they are perceived by their peers, than they are by the effects of excessive alcohol intake.

6. Alcohol – is it a problem? • Health: • Alcohol related liver disease has increased 100% in the last 10 years. • Emergency admission rates for people with primary & secondary diagnoses of acute intoxication and harmful use (associated with binge drinking) shows admission rates for Grampian are significantly higher than rest of Scotland. • Other health harm can be related to risk-taking behaviours, for example unprotected sex, transmission of STI and unwanted pregnancy

7. Alcohol – is it a problem? Alcohol Related Deaths: • In 2004 Grampian had 107 alcohol related deaths (from 2052 reported in Scotland). • There has been a 21% rise in such deaths in Scotland in only FIVE years. • In 1990 alcohol related deaths accounted for 1 in 100 deaths in Scotland. In less than 10 years this had risen to 1 in 40. • It is accepted that such figures are often incomplete given miscoding of deaths or lack of recognition of alcohol as a contributing factor.

8. Alcohol - Social harm In Scotland the economic cost of alcohol related harm was estimated at over £1.1 billion in 2002/03 Personal - impact on relationships, employability, confidence, finances Alcohol is a contributory factor in: • 40% of violent crimes • 39% of deaths in fires • 15% of drownings • 17% of road traffic deaths

9. Alcohol -short term physical effects: • Nausea and vomiting • Slowed heart rate • Coma • Death • Uncoordinated muscle movements • Slurred speech • Drowsy/sleepy • Increased sexual arousal • Decreased sexual performance • Sensory impairment • Headache • Sweating

10. Alcohol - long term physical effects: • Brain shrinkage • Oesophageal varicies • Liver damage – hepatitis, cirrhosis • Skin dehydration • Impotence • Reduced kidney function • Cancers – breast, throat, mouth, stomach, colon • Pancreatitis

11. Long term physical effects (continued) • Fatty deposits on the heart • Gastritis, stomach ulcers • Inflammation of intestines, reduced ability to absorb nutrients • Peripheral neuropathy • Foetal Alcohol Syndrome (FAS) • Alcohol Related Brain Damage (ARBD) • Physical dependency • Alcohol tolerance

12. Alcohol - mental/emotional effects Short term • Lower reasoning ability • Exaggerated state of emotions • False self confidence Long term • Depression • Anxiety • Phobias • Paranoia • Psychological dependency • Suicidal thoughts

13. Harmful drinking patterns • Chronic drinking – drinking large amounts of alcohol regularly, often associated with alcohol dependence • Binge drinking – drinking excessive amounts of alcohol in a short period of time with the specific objective of getting drunk. Some may do this regularly or it may be occasional

14. Alcohol dependence • Drinking begins to take priority over other activities. Becomes a compulsion • Tolerance develops, it takes more alcohol to produce drunkenness • Withdrawal symptoms such as anxiety, tremor develop and are reduced by taking more alcohol. • Often undetected for years – may be masked by availability and acceptability • May be a genetic component – alcohol dependence clusters in some families, but it’s hard to be certain this is not learned behaviour

15. Delirium tremens (DTs) • Caused by cessation or reduction in alcohol intake • Usually where prolonged heavy drinking has been a feature • Effects include, fast heart rate, sweats, high blood pressure, marked tremor, vivid hallucinations and agitated behaviour • Can lead to seizures • Can be fatal if untreated

16. Korsakoff’s syndrome • Caused by lack of Vitamin B1 (Thiamine) which affects brain & nervous system • Alcohol use is often cause of this deficiency – poor diet in heavy drinkers over longer term. Alcohol also affects how well body absorbs key vitamins • Brain damage can occur if untreated (with Vit B1) • Results in severe short term memory loss, difficulty acquiring new skills, lack of insight into condition, talkative and repetitive behaviour • Younger cases now being reported

17. How can people get help? • Prescribing – Antabuse, Acamprosate, Naltrexone • Talking based treatments – Cognitive Behavioural Therapy (CBT), Motivational Interviewing, Counselling • Range of voluntary and statutory services

18. Confusion about units.... • Advice has been conflicting • Awareness of units concept • Interest in units concept • In 2006 a Student Survey in Edinburgh concluded that only 2% of females and 4% of males understood the unit concept. • 9 out of 10 did not use units to calculate alcohol intake

19. Sensible Drinking Guidelines Women - up to 2-3 units of alcohol a day, not exceeding a total of 14 units per week – with at least 2 alcohol free days per week • Men - up to 3-4 units of alcohol a day, not exceeding a total of 21 units per week – with at least 2 alcohol free days per week • Young people – there’s no safe limit for young people • Takes 1 hour for the body to process 1 unit of Alcohol The emphasis is now on daily units to discourage heavy binge or weekend drinking

20. How much is too much? • Large glass wine (250 ml) at 13% ABV = 3 units • Average glass wine (175 ml) at 13% ABV = 2.3 units • Lager/beer (440 ml can) at 3.5% ABV = 1.5 units • Lager/beer (440 ml can) at 5% ABV = 2.2 units • Pint of strong lager (5% ABV) = 2.8 units • 25 ml measure of spirit (e.g. gin, vodka etc.) = 1 unit • 330ml bottle of beer/lager/alcopop at 5% ABV = 1.7 units

21. Alcohol & pregnancy - new recommendations from CMO: “Avoid alcohol if pregnant or trying to conceive”

22. Foetal Alcohol Syndrome (FAS) & Foetal Alcohol Spectrum Disorder (FASD) FAS: • Characteristic minor abnormalities of the face • Growth restriction – pre & post natal • Neurodevelopmental problems • Maternal alcohol consumption has been high FASD: • Studies have shown that elements may be present where maternal alcohol consumption has been more moderate • 1 of 3 FAS features may be present, thought to most commonly be neurodevelopmental problems

24. ABV & Unit labelling

25. Responsible drinking tips • Remember - It is fine not to drink alcohol. 5-10% of the population choose not to drink alcohol • Drink water or soft drinks between alcoholic drinks • Eat before or during drinking • Drink tall mixers & avoid neat spirits • Drink ‘purer’ drinks. Clearer drinks have less congeners • Pace yourself, be wary of getting involved in rounds • Keep an eye on the strength and volumes of drinks • Home measures are often larger than pub measures • Drink plenty of water before going to bed • Plan your night out, think about how you will get home etc. • Look after your friends, if their in a bad way help them out

26. Source of further information: www.infoscotland.com/alcohol

27. Thank You fraser.hoggan@nhs.net neil.strachan@nhs.net Stephen.hounsom@moray.gov.uk